Serotonin
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Serotonin | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
SEROT
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
6.5 mL (minimum 3.0 mL)
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
1. Patients should not eat avocados, bananas, butternuts, cantaloupe, dates, eggplant, grapefruit, hickory nuts, honeydew melon, kiwifruit, melon, nuts, pecans, pineapple, plantains, plums, tomatoes, or walnuts, which are high in serotonin for 48 hours before and during collection.
2. Patient should discontinue medications that may elevate urine serotonin concentration including lithium, monoamine oxidaseinhibitors, methyldopa, morphine, and reserpine. Patient should discontinue use of selective serotonin reuptake inhibitors (SSRI; eg, PROZAC) that can lead to depletion of platelet serotonin levels and result in falsenegative urine serotonin tests.
Days Performed: Mon, Wed, Fri
Lab/Phone:
330-543-8418
TAT:
5-8 days
Additional Info:
Reference range: < or = 230 ng/mL
CPT Code:
84260
